Sunday, July 08, 2012


Why Obamacare?

Healthcare Provisions and Notes

The Task I set myself was to try to identify the majority of health insurance coverage considerations that sparked Medicare, Medicaid, and now Obamacare. My next step is to attempt to find the equivalent provisions in Obamacare itself. What this taught me was just how complex an issue this is, and why the Obama solution went completely overboard in setting up for administrating the nightmare. None of my items are meant to be solutions as such, but merely identification of the subjects of concern. The other thing I learned was that loading the primary doctors with many difficult decisions, some being life or death, is not necessarily a good idea. But, then, I have no solutions for the overload problem either, and I detest the idea of health boards or death boards that have the power of life or death over us.

So here is my tentative list of subjects and possible provisions:

1. Tort reform

2. Defined ER care covered

3. Affordable health care insurance costs

4. Defined coverage of major health crises

5. Co-pay up front

6. Defined diagnostic and preventive care medical tests covered

7. Defined hospital stays covered

8. Defined list of medical supplies, prosthetic and mobility apparatus covered

9. Defined list of procedures covered

10. Defined list of prescription medications covered-- with no gap

11. Defined list of illnesses covered, including mental illnesses

12. Defined provisions for treatment during pandemics covered

13. No previous conditions can prevent insurance coverage

14. Defined rehabilitation costs covered

15. Defined surgery operating room costs covered

16. Defined doctor and surgeon costs covered

18. Defined life support costs covered

19. Defined organ replacement costs covered

20. Defined medical transportation costs covered

21. Defined nursing care covered

22. Defined home nursing care and home checkups covered

23. Defined long-term care covered

24. Exceptions to the rules and provision for unusual and unplanned medical events to be allowed by doctors and others on a case-by-case basis.

25. Review and possible adjustment on a yearly basis for all provisions.

26. Healthcare for veterans from our wars should be equal to or better than that of ordinary citizens, and should be geared towards the war wounds, accidental wounds and the illnesses that veterans have experienced during their service time. (Responsibility here is for the VA)

27. Patients should be able to select their own doctors if they are within the Medicare system

28. There should be no need for referrals to access specialists.

29. Insurance coverage should not be arbitrarily stopped to avoid high costs of coverage.


It turns out that all of these provisions require informed debate, setting of defined elements and setting of fair bounds in time and cost by both medical insurance organizations, employers and all levels of government involved.

Social Security, Medicare and Medicaid do contribute to just about all of these provisions up to defined limits. The problem is those limits often leave the patient with very large bills to pay, even forcing bankruptcy in some cases. Current insurers also have coverage of most of these provisions that come into play once the government schedules are exhausted.

The federal government often uses regional economic conditions to determine their level of support to citizens residing in the region.

The general goals might be: a) to avoid patients becoming destitute from medical costs; 2) to use humane decisions about medical care across the board; 3) to improve the quality of life for all citizens as economically as possible; and, 4) to utilize free market principles wherever possible in organizing all of the care provisions.

The sources of payment include: 1) patient; 2) patient insurance; 3) government; 4) Charity from various sources, including the hospital and doctors themselves.

All citizens and visitors to the US, including illegal immigrants, should pay towards their healthcare, just as most do now under Medicare/Medicaid/Social Security.

Ability-to-pay determination is a highly controversial subject that requires significant expertise and data.

Termination-of-life decisions must not be left to doctors alone, and must conform to the patient’s own wishes, or his representative’s wishes. There must be no death boards.

Very important aspects of healthcare costs are the fees that doctors and hospitals collect for their services, and the limits placed on them by Medicare, hospitals and insurance companies. The question is what can be done to bring these costs down?

Free care at hospital ER facilities is a huge issue. What can be done to limit this exposure that raises costs for everyone else?

A national identity card that contains each individual’s picture, ID data and medical records, including prescription drugs, may be instituted.

Labels: ,


Post a Comment

<< Home

This page is powered by Blogger. Isn't yours?